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Pro Forma Income Statement Year 1 Year 2 Year 3 Year 4 Year 5 Visits 4,882 5,126 5,382 5,652 5,934 Revenue Per Visit $450 $450

Pro Forma Income Statement
Year 1 Year 2 Year 3 Year 4 Year 5
Visits 4,882 5,126 5,382 5,652 5,934
Revenue Per Visit $450 $450 $450 $450 $450
Gross Revenue
Patient Reveue
Gross Patient Revenue
Deductions from Patient Revenue
Contractual
Total Deductions from Revenue
Net Patient Revenue $0 $0 $0 $0 $0
Operating Expenses
Salaries and Wages
Employee Benefits
Utilities
Repair/Maintenance
Housekeeping
Telephone Service
Depreciation
Malpractice
Miscellaneous/Other
Variable Medical Supply Costs
Other Non-Personnel Costs
Total Operating Expenses
Excess of Rev over Exp. From Operations $0 $0 $0 $0 $0
Cummulative Income $0 $0 $0 $0 $0
Net Cash from Excess Rev (excl Depreciation) $0 $0 $0 $0 $0
Cummulative Income Net Cash $0 $0 $0 $0 $0

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